Mary Lynn McPherson

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498 appearances 2 recordings 1 series first heard Oct 2018 last heard Dec 2021

Mary Lynn McPherson’s voice in public audio — every appearance, attributed to the second.

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GeriPal - A Geriatrics and Palliative Medicine Podcast · All the Questions You Had About Opioids But Were Afraid To Ask: A Podcast with Mary Lynn McPherson · 5 Oct 2018 podcast

So you wanna cut back because of lack of cross tolerance, but the patient was in a ton of pain.

think that also factors into your decision.

While you might cut back some, you wouldn't cut back as much.

if the patient were very, very well controlled and in fact a little bit sedated.

So you have to take all that into consideration.

Then step five is the most important step of all.

It is monitoring your patient like nobody's business.

Because you probably will be off a seat or two in the ballpark.

So that you can't just do this and walk away.

So you have to be very careful to like I'm I'm very fond of asking patients to rate their pain before they take a dose or breakthrough and one hour later, because you peak on your morphine or oxycode or hydromorphone by about forty, forty five minutes.

So at one hour that's as good as it's gonna get.

And then I watch how they do over the next twelve to twenty four hours, maybe forty eight, and then I can adjust things.

the patient can take the fewest doses of breakthrough possible.

step six is billing.

That's step six.

That'll be in edition three, version three of the book.

Nope.

All the opiates are handled by the liver.

So I think uh I would be very, very leery about methadone, particularly if it's somebody with end stage cirrhosis, because that's going to take a long time to get to steady state.

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